INFECTION PREVENTION AND CONTROL NATIONAL SYMPOSIUM ON ANTIBIOTIC STEWARDSHIP & INFECTION PREVENTION AND CONTROL - Right Drug, Right Dose, Right Duration, Right Frequency ASP 2016 January 23rd Hotel Crown Plaza, Kochi
INDEX SL.NO CHATPERS PAGE NO: 1 Hand Hygiene 2 2 Sterilization (CSSD) 4 3 Bio Medical Waste Management 6 4 Medical Asepsis 8 5 Surgical Asepsis 11 6 Housekeeping 14 7 Laundry 16 8 Isolation Practices 18 9 Out Break of Infections 21 1 P a g e
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Sterilization (CSSD) Central sterile supply department (CSSD) is a service unit in a hospital that processes, issues, and controls the sterile stores supply to all departments of the hospital. Workflow in the CSSD: Receipt Cleaning Assembly & Packing Sterilisation Storage 4 P a g e
Flow of Instrument through CSSD The cleaning (or dirty) zone This is the area in which reusable instruments are collected, registered, cleaned and dried. The dirty zone should be easily accessible from the operating, obstetric and surgical emergency departments to facilitate the reception of reusable instruments. It must also be located next to the clean zone. The packaging (or clean) zone This is the area for checking/inspecting instruments, reassembling instrument sets, high-level disinfection, packaging and storage of packages ready to be sterilized It should be located between the dirty zone and the sterile zone The autoclaving (or sterile) zone This is the area in which the instruments ready to be sterilized by steam sterilization in an autoclave are registered.. It is important to ensure that there is enough space on all sides of the autoclave for safe use and maintenance. The storage and distribution zone This is the area in which sterile packages are stored until distributed. It should be located next to the autoclaving zone, in a separate room. 5 P a g e
Bio Medical Waste Management Bio-medical waste means any waste generated during diagnosis, treatment or immunization of human beings or animals. Management of healthcare waste is an integral part of infection control and hygiene programs in healthcare settings. These settings are a major contributor to community-acquired infection, as they produce large amounts of biomedical waste. Biomedical waste can be categorized based on the risk of causing injury and/or infection during handling and disposal. Steps of Bio Medical Waste Management Segregations should be done as in following categories: 6 P a g e
Locations of Containers:- Containers should have different colour bags and should be located at the point of generation of waste Bags: Should ensure that waste bags are filled up to three fourth capacity & tied securely and removed from point of waste generation Certain categories of waste may need pre treatment at the site of generation such as plastic and sharp materials etc. No untreated BMW should be stored beyond 48 hrs. Categories of waste and their method for Disposal 7 P a g e
Medical Asepsis Prevention The most effective preventive measures are avoiding catheterization and removing catheters as soon as possible. Optimizing aseptic technique and maintaining a closed drainage system also reduce risk. Intermittent catheterization carries less risk than use of an indwelling catheter and should be used instead whenever feasible. Antibiotic prophylaxis and antibiotic-coated catheters are no longer recommended for patients who require long-term indwelling catheters Key Points Long-term use of indwelling bladder catheters increases risk of bacteriuria, although bacteriuria is usually asymptomatic. Symptomatic UTI may manifest with systemic symptoms (e.g., fever, altered mental status, decreased BP) and few or no symptoms typical of UTIs. Do urinalysis and urine culture if patients have symptoms or are at high risk of sepsis (e.g., because of immune compromise). Treat similarly to other complicated UTIs. Whenever possible, avoid use of catheters or remove them at the first opportunity. Summary of guidelines for preventing infections associated with the insertion and maintenance of Catheters. 1. Selection of catheter type Use a single-lumen catheter unless multiple ports are essential For total parenteral nutrition, a dedicated CVC or lumen should be used exclusively Use an implantable or tunnelled catheter for long term (>30 days) use Consider the use of an antimicrobial impregnated catheter for patients at high risk of CRBSI 2. Selection of catheter insertion site Balance risks of infection against mechanical risks of insertion Use the subclavian route unless contraindicated Consider the use of peripherally inserted catheters as an alternative to CVCs 3. Aseptic technique during insertion Use optimum insertion technique including sterile gown, gloves and drapes Clean the insertion site with alcoholic chlorhexidene gluconate solution (or alcoholic povidone iodine) and allow to dry 4. Catheter and catheter site care Before accessing the CVC, disinfect the external surfaces of the catheter hub and connection ports with an aqueous solution of chlorhexidene gluconate or povidone iodine (unless against manufacturer's recommendations) Use sterile gauze or transparent dressing over the insertion site Catheter flush solutions should contain anticoagulant 5. Replacement strategies Do not routinely replace non-tunnelled CVCs as a method of CRBSI infection Guide wire exchange is acceptable for malfunctioning catheters if there is no evidence of infection 8 P a g e
Guidelines for the Management of Intravascular Catheter-Related Infections Management points for a patient with bloodstream infection and a tunnelled central venous catheter (CVC) or an implantable device (ID). 9 P a g e
Approach to the management of a patient with a tunnelled central venous catheter (CVC) or a surgically implanted device (ID) related bloodstream infection 10 P a g e
Surgical Asepsis WOUND CARE Your surgical wound may need to be cleaned and the dressing changed on a regular basis. Remove the old bandage and packing. You can shower to wet the wound, which allows the bandage to come off more easily. Clean the wound. Put in new, clean packing material and put on a new bandage. To help some surgical wounds heal, you may have a wound VAC (Vacuum Assisted Closure) dressing. It increases blood flow in the wound and helps with healing. This is a negative pressure (vacuum) dressing. There is a vacuum pump, a foam piece cut to fit the wound, and a vacuum tube. A clear dressing is taped on top. The dressing and the foam piece are changed every 2 to 3 days. Clean Technique for Surgical Asepsis 11 P a g e
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Housekeeping 10-Step Occupied Room Cleaning Process 10-Step Discharge Cleaning Process 14 P a g e
CLEANING AND DISINFECTION OF INPATIENT WARDS 1. The cleaning of a patient's wards will be performed once during each shift. Housekeeping staff with emphasis on patient touch areas such as bed, bed rails, door knobs, handles, monitoring equipment, buttons/controls, cables. 2. After a patient is discharged all used disposable items like IV bags and tubing s, suction catheters and tubing s will be discarded by nurses. 3. Soiled linen is removed by Housekeeping Staff. 4. Clean the bed surface including under the mattress with disinfectant. 5. Toilet cleaning, bathrooms, sinks, showers should be cleaned every six hourly or as when required. Soap and clean towel would be provided and will be refilled as needed. Task Involved in providing Housekeeping Services 15 P a g e
FUNCTIONS OF LAUNDRY DEPARTMENT Functional flow chart of activities in Laundry is as follows: Receipt of Articles Cleaning & Disinfection. Washing Inspection and Assembly Distribution PROCESS FLOW OF MECHANIZED OR IN HOUSE LAUNDRY The layout of the Laundry should be done in such a way that there is a unidirectional flow of materials so that mixing up of the dirty linen and clean linen is avoided. It has following areas: Reception and Receiving Area Sluicing & Disinfection Area for Soiled and Infected Linen Machine Area (for Washing) Drying Area (For Dryer) Sorting Table for torn Clothes Folding and Pressing Area Tailoring Room Clean Storage Area Distribution Area 16 P a g e
Diagrammatic representation of General Laundry system Isolation Practices Setting Up and Carrying Out Isolation Securing order to begin isolation Food service and disposal Stocking isolation cart/cabinet Caring for linen Setting up an isolation room Monitoring blood pressure (BP) Educating the Patient and Family Regarding Isolation Filling water pitcher or ice bag Locating negative and positive pressure rooms Dressings: No-touch techniques Using portable HEPA filter Securing signatures Isolation and precautions labelling Drawing blood for laboratory Obtaining isolation door signs and labels Running an EKG on isolation patient 17 P a g e
Selecting masks Visitors Donning gown, mask and gloves Transporting isolated patients to other departments Removing gown, mask and gloves Patients on isolation leaving the isolation room Collecting specimens from patient on isolation When a patient on isolation codes or requires a code cart Disposing of body discharges Caring for patient after death Taking temperature, pulse and respiration Caring for equipment in the isolation room / bagging of articles Administering medications Terminal cleaning Administering blood products Discharging a patient on isolation / when a room can reoccupied Standard precautions Hand washing and antisepsis (hand hygiene); Use of personal protective equipment when handling blood, body substances, excretions and secretions; Appropriate handling of patient care equipment and soiled linen; Prevention of needle stick/sharp injuries Environmental cleaning and spills-management; and Appropriate handling of waste. Hand washing and Antisepsis (hand hygiene) Contact isolation precautions used for infections, diseases, or germs that are spread by touching the patient or items in the room (examples: MRSA, VRE, diarrheal illnesses, open wounds, RSV). Healthcare workers should: Wear a gown and gloves while in the patient s room. Remove the gown and gloves before leaving the room. Clean hands (hand washing or use hand sanitizer) when entering and leaving the room. Visitors must check with the nurse before taking anything into or out of the room. Droplet isolation precautions used for diseases or germs that are spread in tiny droplets caused by coughing and sneezing (examples: pneumonia, influenza, whooping cough, bacterial meningitis). 18 P a g e
Healthcare workers should: Wear a surgical mask while in the room. Mask must be discarded in trash after leaving the room. Clean hands (hand washing or use hand sanitizer) when they enter the room and when they leave the room. Airborne isolation precautions used for diseases or very small germs that are spread through the air from one person to another (examples: Tuberculosis, measles, chickenpox). Healthcare workers should: Ensure patient is placed in an appropriate negative air pressure room (a room where the air is gently sucked outside the building) with the door shut. Wear a fit-tested NIOSH-approved N-95 or higher level respirator while in the room. Mask must be discarded in trash after leaving the room. Clean hands (hand washing or use hand sanitizer) when they enter the room and when they leave the room. Ensure the patient wears a surgical mask when leaving the room. Instruct visitors to wear a mask while in the room. 19 P a g e
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Out Break of Infection Steps involved: Preliminary Investigation: confirming whether an outbreak is actually taking place and if cases have a common cause Early control measures: Isolation, cohorting and cleaning Clear communication: to alert other staff and patients Descriptive epidemiology: to develop a case definition and identify as many cases as possible in order to quantify the extent of the outbreak. This should be done by means of a properly constructed questionnaire. The outbreak should be described in terms of time, place and person to ensure that its full extent is recognised. Epidemiological assistance may be required for this. Environmental health investigation: to ensure food safety is protected and the kitchen/ food and food workers are not either at risk of contamination or a source of contamination and hence prevent further cases. If a point source is suspected, epidemiological and environmental investigations should be undertaken to identify or exclude a contaminated food or water source. Microbiological investigation: to identify definitively and document the causative pathogen. Analytical studies: more complex analytical studies may be necessary to determine possible exposures and methods of transmission. 21 P a g e
Declaration that the outbreak is over. Production of a final report. Control Measures A. Immediate cleaning and environmental decontamination B. Scrupulous hand washing C. Segregation of those who are ill from those who are not D. Limitation of movement of staff and patients E. Exclusion of any ill staff from work for 48 hours after their last episode of vomiting or diarrhoea F. Sensible management of visiting 22 P a g e